By the clinical team at Next Step Psychiatry • Lilburn, GA
Patients exploring rapid-acting depression treatments in Lilburn often encounter both Spravato and ketamine. While both use ketamine or an esketamine derivative as their active agent, they have important differences. Understanding these distinctions will help you and your psychiatrist determine which treatment is right for you.
What Are Spravato and Ketamine?
Both medications are based on ketamine, an NMDA receptor antagonist with unique antidepressant properties. Ketamine is a dissociative anesthetic that’s been used in surgery and anesthesia for decades. However, at lower doses, ketamine has potent antidepressant effects, often within hours to days—much faster than traditional antidepressants that take weeks.
Spravato is esketamine (the S-enantiomer of ketamine), formulated as a nasal spray, approved by the FDA for treatment-resistant depression. Ketamine in psychiatric clinics is typically racemic ketamine (a 50–50 mixture of both enantiomers) administered intravenously or intramuscularly by psychiatrists in specialized clinics.
Administration Methods
Spravato: Self-administered nasal spray in our clinic. Patients spray the medication into each nostril. Administration takes just a few minutes, and patients rest in our facility for two hours post-administration for monitoring.
Ketamine: Administered by IV infusion over 40 minutes, typically. The psychiatrist inserts an IV line, and ketamine is delivered directly into the bloodstream. Some clinics offer intramuscular injection, though IV is more common.
From a practical standpoint, Spravato’s nasal administration is less intimidating for patients who fear needles. The IV administration of ketamine allows for more precise dosing and potentially faster systemic absorption.
FDA Approval Status and Evidence Base
Spravato has FDA approval as a prescription medication for treatment-resistant depression and, as of 2025, for monotherapy use. It has undergone randomized controlled trials that led to FDA approval. Ketamine (particularly IV ketamine) is not FDA-approved for depression treatment, though it’s used off-label in psychiatric clinics. Much of the evidence comes from clinical experience and observational studies rather than the rigorous FDA approval process.
This difference in approval status is important. Spravato has met FDA standards for efficacy, safety, and consistency. When you receive Spravato, it’s a standardized pharmaceutical product. Off-label ketamine, while often effective, lacks this regulatory oversight. That said, many psychiatrists who use ketamine consider it highly effective based on clinical experience.
Cost and Insurance Coverage
Spravato is a brand-name medication, and its cost is significant—usually thousands per treatment. However, because it has FDA approval, insurance coverage is often more straightforward. Medicaid and Medicare in Georgia, including coverage in the Atlanta area, may approve Spravato for appropriate candidates.
Ketamine clinics typically charge per session, often $400–$1,000 per IV infusion. Since ketamine is off-label, insurance rarely covers it, making out-of-pocket costs the rule. However, some clinics offer packages with slight discounts for multiple sessions.
Treatment Frequency and Duration
Spravato: Typical protocol is twice weekly for two weeks (induction), then weekly for four weeks, then every 1–2 weeks for maintenance. Total treatment duration depends on response and goals.
Ketamine: Common protocols include 6 IV infusions over 2 weeks, then maintenance infusions typically every 1–2 weeks. Some clinics use different schedules.
Both require ongoing treatment—this isn’t a one-time cure. Patients typically need maintenance therapy to sustain antidepressant effects.
Dissociative Effects
Both medications produce dissociative effects—a floating or detached sensation. Spravato nasal spray users typically experience mild-to-moderate dissociation. Ketamine IV patients often experience more pronounced dissociation, sometimes described as more intense. Some patients find this therapeutic; others find it distressing. At Next Step Psychiatry, we prepare patients and provide support during this experience.
Efficacy for Different Conditions
Both show rapid antidepressant effects. Spravato is specifically approved for major depressive disorder. Ketamine, based on clinical observation, may be used off-label for bipolar depression, PTSD with depression, and treatment-resistant OCD, though evidence is less robust than for major depression.
Choosing Between Them in Lilburn
The choice between Spravato and ketamine depends on multiple factors: approval status and insurance coverage, your comfort with nasal spray versus IV administration, access to clinics offering each treatment, and your psychiatrist’s clinical judgment. At Next Step Psychiatry, we thoroughly discuss both options, help patients understand the differences, and make evidence-based recommendations for your specific situation.
Call 678-437-1659 to discuss which rapid-acting treatment is best for you.
This article is for informational purposes only and is not a substitute for professional medical advice. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.